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b <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> UNDERGROUND STORAGE TANK <br /> MONITORING PLAN — (Page 2 of 2) Check a7f <br /> VI. UNDER DISPENSER CONTAINMENT (UDC) MONITORING mato I0 <br /> UDC MONITORING IS PERFORMED USING THE FOLLOWING NIETHOMSi <br /> D CHAIN ASSEMBLY L-33 ELECTRONIC STANDALONE <br /> 10 [FLOAT AN <br /> 1 CONTINUOUS ELECTRONIC NIT RING <br /> ❑ 4 NOUIS_P-EN-SER—S T210 99/OTHER(SPen )_ criyMODELN.-_— ( <br /> EA` MONITOR MANUFACTURER <br /> Jx =x <br /> NIODEL a15 f._ <br /> LEAK SENSOR MANUFACTURER. ❑ a YES NO <br /> DETECTION OF A LEAK INTOTHE UDC TRIGGERS AUDIBLE AND VISUAL ALARMS <br /> ❑ a.YES Lal g NO <br /> UDC LEAK ALARM TRIGGERS AUTOMATIC"PUMP SHUTDOWN y (Th NO Jwia,l <br /> FAILUREiDISCONNECTION OF UDC MONITORING SYSTEM TRIGG@RS AUTOMATIC PUMP SHUTDOWN V/ YES ❑ b_NO °x'b <br /> GDC MONITORING STOPS THE FLOW Of ODUCT AT TI1E DISPENSER - -_ ---.._____.. <br /> -__-______.__ .___-_JAJ <br /> _.._ .SINGLE WALL ❑ <br /> 2 DOUBLE WALL <br /> UDC CONSTRUCTION IS. <br /> IF DOUBLE WALL. PRESSURE ❑ c.VACUUM <br /> UDC INTERSTITIAL SPACE IS MONITORED BY. ❑ a.LIQUID ❑ b. Jx.rws <br /> S. ❑ a <br /> A LEAK WITHIN THE SECON DAR CONTAINMENT OF THE UDC TRIGGERS AUDIBLE AND V ISUAL A LARM .YES [:] b.NO <br /> VII. PERIODIC SYSTEM TESTING Alas <br /> I Ei.D TESTING. THIS FACILITY HAS BEEN NOTIFIED BY 'I HE STATE WATER RESOURCES CONTROL BOARD THAT FNH.ANCED <br /> MUST BE PERFORMED. PERIODIC ELD IS PERFORMED EVERY 36 MONTHS AS RE I11RED.la3ccx 2—1I Jws86 <br /> ® 2.SECONDARY CONTAINMENT COMPONENTS ARE TESTED EVERY 36 MONTHS. JAsar <br /> L® 3 SPILLBUCKETSARETESTEDANNUALLY. VID. RECORD KEEPING <br /> — Jsou <br /> The following monitoring/nuintenancc records art kala[for this facihry. <br /> ® a ALARM LOGS ❑ h.VISUAL INSPECTION RECORDS ❑ e.TANK GAUGMGYRESULTS(nd supporting documentation records) <br /> ❑ d.SIR TESTTG RESULTS(and supporting documenution records) ❑ <br /> ❑ f ATG TESTING RESULTS(end supporting documenution records) ❑ g CORROSION PROTECTION 60-DAY LOGS <br /> h.EQUIPMENT MAINTENANCE AND CALIBRATION RECORDS <br /> IX. TRAINING a9tiaA <br /> Personnel wnh UST monitoring responsibiM1ties ere familiar wiN ell of the folbwmg ducumenu relevant to then job duties.a <br /> REFERENCE DOCUMENTS MAINTAINED AT FACILITY fChcck aft char apply) / ,w�vs. <br /> M THIS UNDERGROUND STORAGE TANK MONITORING PLAN(Required) <br /> l 1 O OPERATING MANUALS FOR ELECTRONIC MONITORING EQUIPMENT (Required) ,Ara„e <br /> V I ` ALIFORNIA UNDERGROUND STORAGE TANK REGULATIONS <br /> 0 JAFr,;e. <br /> CALIFORNIA UNDERGROUND STORAGE TANK LAW <br /> ❑ STATE WATER RESOURCES CONTROL BOARD (SWRCB) PUBLICATION: -HANDBOOK FOR TANK OWNERS - MANUAL AND <br /> STATISTICAL INVENTORY RECONCILIATION- <br /> 0 SW RCB PUBLICATION."UNDERSTANDING AUTOMATIC TANK GAUGING SYSTEMS" <br /> J9O6A <br /> ❑ OTHER(Specify)r Jv�r1a <br /> This faaliry has a"Designa[ed UST Operator"who hes passed the Cahfomia UST System Operator Exam administered by the Irtcmational Code Council <br /> (JCC) The "D�signeted US'f Operator"will train facility empioytes in the proper operation end maintenance of the UST systems annually,and within 30 <br /> days of hire This training will include,but is not limited to,ted following. <br /> ✓Operation oI, he UST systems in a manner consistent with the facilit)'s best management Practices i <br /> 1/The fecility employee's role with regard to the monitoring equipment as specified in this UST Monitoring Plan. <br /> ✓The facility employee's role with regard to spills and overfills as specified in the facility's UST Response Plan. <br /> I/Names)of contact person(s)for emergencies and monitoring alarms. <br /> X. COMMENTS/ADDITIONAL INFORMATION JA4r1 <br /> Pro idea I��naT9�—menLs here orendicate how many pages with additional mf atum qr.speciBc�uar lattice uresue a S . <br /> XI. PERSONNEL RESPONSIBILITIES <br /> 1'he UST O ner/Operetor it responsible for ensuring that. L)the daily/routine UST monitoring activities end maintenance of UST leak dexcii equipment covered <br /> I by inis.pl —curs;mall condif nz W, indicate ossible release arc investigated and i L. monitoring records are mamuined�rokedy. <br /> r THE FO W✓ G PERSON/ SPONS LE FOR PERFORMING THE MONITORIINNG.A,NDt EQUIPMENT MALNT'ENANCE <br /> NAME �f mxnn TITLE. �afrt/_ 91 <br /> NAME: _ JANa TITLE: +Axrs <br /> The Designated USI'Operator shall perform a monthly visual inspection of the facility,provide a report to the owner/operator,and inform the owner/operator of any <br /> conditions that need follow-up action. <br /> _ XII. WNER/OP RATORSIGNATURE <br /> CERTIFICATION:1 certAy Ablitt the iialitrimattIalia priiallided.ber a true and accurate to theDes[_of owleu . _ <br /> APPLICANT SIGNATUREDATE Jal-n <br /> REPRESEMING_err.TmII tuMnietlR n ivadOnM JAi.ta <br /> APPLICANT NAME(print) aw.r APPLICANT TITLE. <br /> VPCF UST-D(12/2007)-3/6 ww.unidaes.org <br />